Hospital Cost Cutting Could Trigger Lawsuits

Regarding “Drug Costs Are Target of Long Beach Hospital Pharmacist,” Jan. 3:

It is admirable for a hospital to try to reduce or contain costs, but when it does so in a way that may be detrimental to a patient’s health, it opens itself up to lawsuits.

Cost savings need to be weighed against the hospital’s legal liability for denying patients drugs that have been prescribed for them by their doctor.

Case in point: One of the drugs that pharmacist Melinda Klein successfully removed from her hospital’s formulary is Xopenex. Our 4-year-old son has an asthmatic condition for which his pediatrician prescribed Xopenex and another drug. We soon discovered that our health insurance company, Blue Shield of California, felt the same way about Xopenex as Ms. Klein; the insurer removed the drug from its formulary and substituted albuterol.

We tried the albuterol for several weeks and found that it was nowhere near as effective as Xopenex.

The Xopenex treatment stopped our son’s attacks immediately and lasted four to six hours. The albuterol treatment reduced his coughing and wheezing but did not stop them and wore off after only two hours.

After months of battling our insurance company, I contacted the state of California’s Department of Managed Health Care. It agreed to send our case out for independent review by a specialist.

The specialist cited several studies that clearly demonstrated the superior effectiveness of Xopenex over albuterol, particularly in children. The department contacted our insurance company and mandated that it approve (and pay for) Xopenex.

In these days of healthcare profiteering, consumers must know their rights and vigorously exercise them.

The Department of Managed Health Care can be reached at (888) 466-2219 or www.hmohelp.ca.gov.

John N. Heathcliff

Montecito Heights